Endocarditis

Endocarditis (Fever, murmur, malaise and petechia or heamaturia)

A definite diagnosis of endocarditis (Duke's criteria) is achieved when 2 major criteria are present, or 1 major and 3 minor criterias. Major criteria: blood culture positive for typical organisms persistent bacteremia positive ECHO for vegetations abscess or valve dehiscence Minor criteria: valvular heart disease or IV drug user fever greater than 38°C vasculitis skin lesions suggestive ECHO (but not definite) positive blood culture

MC organism Strep.viridans, post prothetic valve operation is Staph epidermitis within 60 days is MC organism. IV drug user, pt. with prolonged vascular cath>> Staph. Aureau. genitourinary disease or procedures Enterococc . GIT malignancy, strep.bovis

One of the major dangers with aortic valve endocarditis is an aortic root abscess. This can lead to prolonging of the PR interval by erosion into the adjacent AV node, hence daily ECGs are useful for monitoring. Use CRP or plasma viscosity for monitoring

1st investigation of choice TTEho, but the investigation of choice specially prothetic valve TOE

Antibiotic: start with penicillin and gentamicin, vancomycin if staph. Suspected or penicillin allergy.after culture result, if strept continue with same antibiotic, if staph use flucxacillin or vancomycin + gentamicin. If enterococci use ampicillin + gentamicin

Fever persistant search cause, drug, Infection, pulmonary embolism or cardiac abcess formation

Patients at risk of endocarditis should beno antibiotic required unless the procedure in infective focus)

– Advised to maintain good oral hygiene

– Told how to recognize signs of infective endocarditis and advised when to seek expert advice